Mycotic pseudoaneurysms in a CAPD patient.

12 (52%) had perfusion defects on MCE. Significant CAD was revealed on angiography in 10 (43.5%) patients: in 4 (17.4%) single-vessel and in 6 (26.1%) multi-vessel disease. To investigate diagnostic performance of MCE in detection of significant coronary lesion, we performed a vessel-based head to head comparison with coronary angiography for three different regions supplied by LAD, Cx and RCA respectively, in every patient. Results are exposed in Figure 1. Altogether we did not notice false negative MCE results. The sensitivity of MCE for detecting significant coronary stenosis as well as negative predictive value was 100% for the three investigated regions. Specificity and positive predictive value were the lowest for LAD: 72 and 50%, while for Cx were 81 and 70% and for RCA 83 and 62.5%, respectively. MCE enables investigation on myocardial tissue perfusion, as well as the spatial extent of microvascular obstruction. MCE has previously been validated as the reference technique for evaluation of myocardial perfusion, particularly in the setting of myocardial infarction [2,3]. To our knowledge, this report is the first to apply MCE in patients on HD for this purpose. Contrast media applied for MCE contain high-molecular-weight gases exhaled, not eliminated by kidneys, thus not contraindicated in patients with renal failure. In our opinion, two episodes of CA were related to coronary angiography and not to the contrast agent. Impaired myocardial perfusion was detected in as much as 65% of our patients. Compared with those with normal perfusion, patients with perfusion abnormalities were at higher risk for cardiovascular events despite a short FU time. Prognostic value of echocardiographic and nuclear imaging techniques in ESRD patients was largely investigated, but with non-uniform results. However, Rabbat et al. [4] in a meta-analysis concerning prognostic utility of two techniques of myocardial perfusion assessment (thallium scintigraphy and dobutamine stress echocardiography) found that both are useful in predicting future myocardial infarction or cardiac death in patients with ESRD. Coronary angiography confirmed significant coronary stenoses in 10 out of 23 patients, while perfusion disturbances in MCE were detected in 12. Thus, agreement between MCE and coronary angiography in a patient-by-patient analysis was good (no disease) with a tendency of MCE to overestimate the severity of CAD. Our preliminary results indicate that MCE is an uncomplicated and safe method of perfusion assessment in patients with ESRD at a bedside. MCE results might be useful for risk stratification in HD patients. MCE seems to be a valuable tool in predicting the presence of significant coronary artery stenosis in patients with ESRD.